Ddx Flashcards
Mucopolysaccharidosis a group of inherited dx in which the body is unable to break down mucopolyssachrides
Symptoms: - macrocephaly - umbilical hernia or ingunal hernia - hydrocephalus - heart valve abnormalities - distinctive facies - macroglossia - hepatospleenomegaly - carpal tunnel syndrome - spine stenosis -
If baby has central cyanosis
Ddx: - congenital heart disease
Bluish colouration of skin
- respiratory problems
- cardiac problems
- methaemoglobinemia
Large fontanelle, seperation sutures, delayed closure of fontanelles
- raised ICP
- hypothyroidism
- rickets
Macrocephaly
- subdural haematoma
- hydrocephalus
- ingerited syndromes such as Beckweith, muco…
- familial macrocephaly
Low set ears
- associated with renal tract anomalies
Pierre robbin syndrome
- micrognathia or underdeveloped jaw
- backward displacement of tongue
- air obstruction
- cleft palate
- repeated ear infections
- batal teeth
Scaphoid abdomen
- diaphragmatic hernia
- duodenal atresia
Distended abdomen
- intestinal obstruction Peristalsis From left to right is high IO Peristalsis From right to left is low IO - perforation - free gas in the liver
Pneumatosis intestinalis
Pneumatosis intestinalis (PI) refers to the presence of gas within the wall of the small or large intestine. Intramural gas can also affect the stomach, but this condition is referred to as gastric pneumatosis
Absence of Moro reflex
- suggests cerebral damage
Cranial nerve one
Smell-ability of each nostril to different smells
Cranial nerve 2
Visual acuity, visual fields, pupils (size, shape, reaction to light and consensual); Fundoscopy: papilloedema, optic atrophy, cataract
Cranial nerve three
Occlumotor nerve palsy
Palsy: Unilateral ptosis, fixed dilated pupil, eye down and out
third nerve palsy may be present at birth (congenital), and the exact cause may not be clear. Acquired third nerve palsy can be associated with head injury, infection, vaccination, migraine, brain tumor, aneurysm, diabetes, or high blood pressure.
Cranial nerve four
Cranial nerve four
Trochlear nerve palsy: Diplopia (when both eyes are open) on looking down and away from the affected side
The fourth cranial nerve is in charge of the superior oblique muscle which turns the eye ineard and downward
Diploplia
Ddx:
- cranial nerve four
- myasthenia gravis
- graves disease
- Wernicke syndrome
Trigerminal (5) palsy
Palsy: Motor-jaw deviates to the side of lesion
Sensory: Corneal reflex lost
Abducens (6) nerve palsy
Convergent squint
An Esotropia, or convergent squint, is when an eye turns inwards. Esotropia (convergent squint) You can have squints that are there all the time (constant) or a squint that appears occasionally and the eyes are straight the rest of the time (intermittent).
Facial nerve lesions/ cranial nerve 7 palsy/ bell’s phenomenon
Weakness Only the lower two-thirds is affected in UMN lesions, but all of one side of the face in LMN lesions. Ask the child to screw-up eyes, raise eyebrows, blow out cheeks, and show teeth
Vestibulocochlear and glossopharyngeal
Hearing, balance and posture
Vagus (10) cranial nerve
Gag reflex: Look at palatal movement
Spinal accessory (11) cranial nerve
Trapezii: Shrug your shoulders
Hypoglossal (12) cranial nerve
Tongue movement: Deviates to the side of lesion
Cerebrllum function
DANISH
Jerk nystagmus (worse on gaze away from midline)
• Truncal ataxia (if worse when eyes closed then lesion is of dorsal columns; not cerebellum)
• Intention tremor: Ask the child to pick up a small object and watch for tremor
• Past pointing: Ask the child to cover one eye with one hand and with the index finger of the other hand ask him to touch his nose and then touch your finger
• Gait: Ask the child to walk normally and then walk heel—toe look for ataxic gait.
Slurred speech
Dysdochokinesia
Reflex
Arms: Biceps (C5, C6)
Triceps (C7,C8)
Lower limps:
Knee: (L3,L4)
Ankle (S1,S2)
Delay in disappearnace of primitive reflexes suggest
Cerebral damage
